Interrelationships among whole-body skeletal muscle mass, masseter muscle mass, oral function, and dentition status in older Japanese adults.

BACKGROUND: Generalized loss of skeletal muscle mass (SMM) may modulate or otherwise affect the loss of masseter muscle mass and be responsible for low masseter muscle performance and strength (i.e., low oral function). Moreover, dentition status can affect oral function independent of the muscle state. This cross-sectional study aimed to simultaneously investigate the relationships among whole-body SMM, masseter muscle mass, oral function (masseter muscle performance and strength), and dentition status in 1349 Japanese adults (mean age = 73.6 years). METHODS: We determined the estimated masseter muscle mass (e-MMM) based on morphological measurements of the masseter muscle. Masseter muscle performance was assessed via masticatory performance evaluation scores using gum, and strength was assessed as the maximal occlusal force. Dentition status was assessed as the number of functional teeth. SMM was measured by bioelectrical impedance analysis. Structural equation modeling stratified by sex was employed to investigate associations among SMM, e-MMM, gum score, occlusal force, and number of functional teeth. RESULTS: The direct path from SMM to e-MMM was statistically significant, as was the direct path from e-MMM to oral function (gum score and maximum occlusal force) for both sexes. We additionally confirmed that SMM indirectly affected gum score and maximum occlusal force via e-MMM (men; standardized coefficient [95% CI] = 3.64 [1.31 to 5.96] for maximum occlusal force and 0.01 [0.01 to 0.02] for gum score, women; 2.01 [0.38 to 3.81] for maximum occlusal force and 0.01 [0.002 to 0.01] for gum score). The number of functional teeth had direct effects on e-MMM, gum score, and maximum occlusal force. CONCLUSIONS: Low SMM was significantly indirectly associated with poor oral function through a low masseter muscle mass, and dentition status was independently associated with oral function.

Relationships among peak expiratory flow rate, body composition, physical function, and sarcopenia in community-dwelling older adults.

BACKGROUND AND AIM: Although respiratory muscle strength is known to decrease with age, the relationship between pulmonary function and sarcopenia remains to be examined. The present study aimed to determine the relationship between peak expiratory flow rate (PEFR) and skeletal muscle mass/sarcopenia in community-dwelling older adults. METHODS: We utilized data from 427 older adults (age 74.4 ± 5.3 years, men/women 157/270) who had participated in the 2015 Otassha Kenshin, a longitudinal study that excluded participants with air-flow limitations. Diagnoses of sarcopenia were based on criteria outlined in the Consensus Report of the Asian Working Group for Sarcopenia and adjusted for Japanese individuals. We compared body composition, physical function, and lung function between patients with and without sarcopenia. Receiver operating characteristic analysis (ROC) for sarcopenia was performed using PEFR, calf circumference, and body mass index. RESULTS: Sixty-five participants (men/women 12/53) were diagnosed with sarcopenia. Patients with sarcopenia were older than those without sarcopenia, and had lower height, weight, body mass index, skeletal muscle mass, appendicular skeletal mass, and skeletal muscle index. Stepwise multiple regression analysis identified whole-body skeletal mass as an independent factor for PEFR. ROC analysis of sarcopenia identified a cut-off value of 5.0 L s for PEFR, with a sensitivity of 0.62, specificity of 0.77, and area under the curve of 0.73 (95% CI 0.67-0.79; P < 0.001). DISCUSSION AND CONCLUSION: Our findings suggest that physical function is more strongly associated with respiratory muscle mass than total skeletal muscle mass and that PEFR may be a valid indicator of sarcopenia.

Morphological and qualitative characteristics of the quadriceps muscle of community-dwelling older adults based on ultrasound imaging: classification using latent class analysis.

BACKGROUND: Muscle thickness and echo intensity measured using ultrasound imaging represent both increased muscle volume and connective tissue accumulation. In combination, these ultrasound measurements can be utilized for assessing sarcopenia in community-dwelling older adults. AIMS: This study aimed to determine whether morphological and qualitative characteristics classified by quadriceps muscle thickness and echo intensity measured using ultrasound are associated with muscle strength, physical function, and sarcopenia in community-dwelling older adults. METHODS: Quadriceps muscle thickness and echo intensity were measured using ultrasound imaging in 1239 community-dwelling older adults. Latent class analyses were conducted to classify participants based on similarity in the subcutaneous fat thickness (FT), quadriceps muscle thickness (MT), subcutaneous fat echo intensity (FEI), and muscle echo intensity (MEI), which were assessed using ultrasound imaging. RESULTS AND DISCUSSION: Morphological and qualitative characteristics were classified into four types as follows: (A) normal, (B) sarcopenic obesity, (C) obesity, and (D) sarcopenia type. Knee extension strength was significantly greater in A than in B and D. FT and percent body fat were greater in C than in the other types. The correlation between the ultrasound measures and knee extension strength differed among the classification types. The classification types were significantly associated with sarcopenia prevalence. CONCLUSIONS: Classification of the morphological and qualitative characteristics obtained from ultrasound imaging may be useful for assessing sarcopenia in community-dwelling older adults.

[Predictors of social isolation among older people living in urban area: a prospective study].

Objectives　We aimed to investigate the predictors of social isolation among older people living in urban area.Methods　A mail survey was sent out to 7,015 elderly subjects living in nine districts of Itabashi ward. At baseline (2012), 3,696 subjects and at follow-up (2014) 2,375 replied to the self-administered questionnaire. We defined social isolation as seeing friends or relatives less than two or three times a month. Gender, age, self-rated health, present illnesses, instrumental activities of daily living (IADL), frequency of going out, frequency of social participation, family structure, and perceived financial status were also investigated. A t-test, a chi-square test, and logistic regression analysis were conducted to examine the predictors of social isolation in a follow-up study.Results　Of the 1,791 subjects who were analyzed for social isolation, 348 (19.4%) were found to be socially isolated in 2014. A multiple logistic regression analysis showed that men (adjusted odds ratio, 1.88; 95% confidence interval, 1.41-2.50) were significantly more likely to be isolated than women. Being older (1.03, 1.01-1.06) was also a significant predictor of isolation. Subjects who participated in group activities one to three times a month (1.62, 1.04-2.53) were significantly more likely to be isolated than those who participated in them more than once a week. Subjects who rated their financial status as low (1.67, 1.20-2.32) were more likely to be isolated than those who rated it as high. Subjects who were isolated (10.24, 7.60-13.81), and those who did not respond to questions about isolation (8.15, 3.76-17.67), were significantly more likely to be isolated than those who were not isolated at baseline. Among the subjects who were not isolated at baseline, being male (2.39, 1.57-3.64) and lower self-rated health (3.99, 1.33-11.94) were predictors of social isolation.Conclusion　Participation in social activities is effective in preventing social isolation among elderly men living in urban area.

Physical and psychological characteristics of the community-dwelling elderly with heart disease.

Objectives Although the survival rates of patients with heart diseases, such as myocardial infarction and heart failure, have increased, the incidence of heart disease in elderly individuals has also increased. We compared characteristics of the community-dwelling elderly with heart diseases (heart disease group) and without heart diseases (non-heart disease group).Methods A total of 758 elderly individuals participated in our survey ("Otassha-kensin") in 2014. The heart disease group (47 men, 28 women) and the non-heart disease group (263 men, 420 women) were selected from among these participants. Data on comorbidities, medications, the Kihon check list (KCL), and social background (lifestyle, exercise habits, certification for using long-term care insurance, and Japan Science and Technology Agency Index of Competence [JST-IC]) were obtained through interview. Body composition, grip strength, 5 walking time (usual pace, maximum speed), timed-up and go test (TUG), single-leg standing time, cognitive function, and depression were evaluated to assess physical and psychological function. Frailty was defined by the KCL. For between-groups comparisons, the Student t-test and Mann-Whitney U-test were used. To determine factors related to heart disease with functional decline, we used a multiple logistic regression analysis with the group (the non-heart disease group [0] and the heart disease group [1]) as the dependent variable and the decline in physical and psychological function as the independent variable.Results Men in the heart disease group had less grip strength, worse balance, and lower JST-IC scores than did men in the non-heart disease group. Women in the heart disease group had greater 5 walking times (usual pace, maximum speed) than those in the non-heart disease group. Both men and women in the heart disease group overall used more drugs and statins, and medications for heart disease than did participants in the non-heart disease group. In the multiple logistic regression analysis, 5 walking time (maximum speed) was shown to be associated with heart disease.Conclusions The community-dwelling elderly with heart disease showed declined physical functions. Our results suggested that these functional declines may be induced via medication and/or declines in daily activity.

Physical and sociopsychological characteristics of older community residents with mild cognitive impairment as assessed by the Japanese version of the Montreal Cognitive Assessment.

BACKGROUND: Although mild cognitive impairment (MCI) criteria are disputable, characterizing various aspects of operational MCI (O-MCI) may lead to a better understanding of potential modulators of cognitive decline and contribute to more effective public health strategies. The aim of the study is to examine characteristics of community-dwelling elderly people with MCI assessed using Japanese version of Montreal Cognitive Assessment (MoCA-J). METHODS: A total of 913 community-dwelling Japanese (65-84 years) participated in health examinations in Tokyo, 2011. The MoCA-J, Mini-Mental State Examination (MMSE), and other physical and mental tests were conducted. Excluded were those with <24 MMSE scores. Those with <26 in MoCA-J were divided into 2 subgroups, (A) participants independent of instrumental activities of daily living (IADL) and no memory complaints and (B) participants independent of IADL with memory complaints or partially dependent on IADL with/without memory complaints. Those with ≥26 in MoCA-J and subgroup (A) of MCI were the normal controls (NCs, 57.4%), and subgroup (B) of MCI was O-MCI, 36.5%. We compared each variable between NC and O-MCI, using logistic regression analysis, adjusted for gender and age. RESULTS: The majority of all the groups were independent of IADL. The O-MCI characteristics were increased depressive symptom, worse self-rated health, lower systolic blood pressure, poorer intellectual activities, no hobbies, weaker grip strength, and slower than usual walking speed compared to the NC group. CONCLUSIONS: Older persons with O-MCI defined by MoCA-J have partially decreased cognition and physical and sociopsychological functions.

Low Dietary Variety and Diabetes Mellitus Are Associated with Frailty among Community-Dwelling Older Japanese Adults: A Cross-Sectional Study.

The association between dietary diversity and frailty remains unknown in older people. We evaluated whether a limited dietary variety is associated with frailty in older adults with diabetes mellitus (DM). This cross-sectional investigation included 1357 adults (median age: 77 years, women: 61.3%). DM was determined by self-reporting, the Dietary Variety Score (DVS) was used to evaluate dietary variety, and the revised Japanese version of the Cardiovascular Health Study criteria evaluated frailty. Participants were divided into 4 groups: no DM/high DVS (non-DMHV), no DM/low DVS (non-DMLV), DM/high DVS (DMHV), and DM/low DVS (DMLV). The prevalence of frailty in each group was 3.6%, 6.7%, 6.7%, and 12.2%. After adjusting for covariates, logistic regression analysis revealed the highest odds ratio (OR) of frailty in the DMLV (non-DMLV, OR = 2.18 (95% confidence interval (CI): 1.25-3.83); DMHV, OR = 1.87 (95% CI: 0.63-5.52); DML, OR = 5.03 (95% CI: 2.05-12.35)). Another logistic regression analysis revealed that a low DVS and DM were independently associated with frailty. Both a low dietary variety and DM were independently related to frailty in older people and the combination increased the prevalence of frailty. These findings suggest that high dietary variety could be important for the prevention of frailty in people with DM.

[Generation of appraisal standards for functional measurements in the frail elderly and persons aged 40 and older requiring light assistance in daily living].

OBJECTIVE: The purpose of this study was to generate appraisal standards for functional measures in independent elderly people with physical frailty, "Tokutei", or persons aged 40 and older who require light assistance, "Youshien". METHODS: A total of 3,852 subjects for whom functional measures were available, including grasp strength, one-leg standing time, timed up & go (TUG) , and 5-m walking time, were analyzed from a database obtained from the Ministry of Health, Labour and Welfare. The upper limit and lower limit of each quintilededuced from the functional measurements were adopted to construct the appraisal standard. RESULTS: The functional measures were higher in Tokutei than in Youshien. Comparing Tokutei and Yoshien, one or more level difference in the five divided groups was observed for the one-leg standing time. There were differences of three or more levels between Tokutei and Yoshien in the TUG and the 5-m walking time. CONCLUSION: The present study allowed development of appraisal standards for elderly having physical frailty and for persons aged 40 and older requiring light assistance in daily living.

[Effects of a motor function improvement program on alleviation of knee osteoarthritis].

AIM: The purposes of this study were to develop a new exercise program for the elderly with knee pain, and to evaluate the effects of the program. METHODS: The participants in the present study were 37 community-dwelling elderly people (75 ± 7 years) with knee pain who were living in Tokyo. The participants were instructed to do a walking exercise with weights attached to each ankle together with an exercise to develop their ability to recognize pain objectively, at a weekly meeting, with training on alternate days at home. The measurements of this study were: one-leg standing time, functional reach (FR), timed up and go, 5 m walking time, knee extension strength, health-related quality of life (QOL) questionnaire (SF-36) and the Japanese Knee Osteoarthritis Measure (JKOM). RESULTS: The total JKOM scores decreased significantly (p<0.01). Each subscale of the JKOM decreased significantly (p<0.05). Furthermore, knee extension strength and FR increased significantly (p<0.01). Among the SF-36 subscale scores, physical functioning, role physical, role emotional and mental health improved significantly (p<0.05). CONCLUSION: The current results suggest that the new program introduced in the present study reduces knee pain and improves the activity of participants.

[Effect of an oral function improvement program based on remote intervention].

AIM: We studied the effect of an oral function improvement program based on the remote intervention by non-specialist assistant as coordinators, who played the role of intermediary between the participants and dental hygienists. METHODS: Among senior citizens aged 65 or older living on pacific islands within the area of greater Tokyo (Tosyobu), 55 people participated in this study. Dental hygienists educated the coordinators beforehand. The participants were evaluated on mastication ability, swallowing ability and oral function-related quality of life (QOL) by dental hygienists before and after the program. The participants did the oral health improvement program every day at home, using materials provided by the dental hygienists. The coordinators reported compliance and questions about the oral function improvement program to the dental hygienists by fax once a week. The dental hygienists replied with technical advice on continuing the exercises, to coordinators by fax. RESULTS: The summed time of 3 times of repetitive saliva swallowing test was significantly reduced (p<0.01). The oral diadochokinesis of articulation function was significantly improved (p<0.01). The color of the mastication function assessment gum significantly improved (p<0.01). Scores on the general oral health assessment index, an index of oral-related QOL, also significantly increased (p<0.05). The items about dental hygiene also improved on the same index. CONCLUSION: Oral function was improved in terms of swallowing, articulation, chewing, hygiene and QOL. This research suggests that the program, in which dental hygienists are involved in a remote way through coordinators, and offer services for oral function improvement, can be effective to improve the oral function of the elderly.

Association between oral, social, and physical frailty in community-dwelling older adults.

OBJECTIVES: Oral frailty (OF) has been shown to be a predictor of disability. Therefore, it is important to be able to identify factors associated with OF in order to prevent long-term dependence. The purpose of this study was to clarify the relationships between OF, social frailty (SF), and physical frailty (PF) in community-dwelling older adults, with the overarching aim of informing the future development of effective measures to prevent frailty. METHODS: Oral, physical, and social function, nutritional and psychological status, and medical history were examined in 682 community-dwelling individuals (267 men, 415 women) aged ≥ 65 years. Ordinal logistic regression analysis with SF and PF as independent variables was performed with pass analysis to determine the relationship between the different types of frailty. RESULTS: Logistic regression analysis revealed significant associations between OF and decline in social function, physical function, and nutritional status, and an increase in the number of medications used. Path analysis showed that SF was directly related to OF and that OF and SF were directly related to PF. CONCLUSIONS: These findings suggest that a decline in social function may directly influence a decline in oral and physical function. The results of this study provide initial evidence, that may guide the future development of measures that aim to prevent and manage OF.

Limitations of SARC-F in the diagnosis of sarcopenia in community-dwelling older adults.

PURPOSE: The SARC-F is a recommended screening tool for sarcopenia; however, its sensitivity is reported to be very low. This study aimed to confirm the diagnostic efficacy of the SARC-F and whether it is affected by population characteristics. METHODS: In this study, 2 cohorts of 1060 community-dwelling older adults, who were monitored by the Tokyo Metropolitan Institute of Gerontology, were included. In addition to the overall dataset, receiver operating characteristic curve analysis was performed to obtain the SARC-F results for sarcopenia among the datasets for only those older in age (over 75 years), those with higher frailty points (above the median total score for the Kihon Checklist points), those with lower grip strength (below the median), lower gait speed (below the median), and those with comorbidities (hypertension, cerebral vascular disease, heart disease, and diabetes mellitus). RESULTS: In the overall dataset, sensitivity and specificity were 3.9% and 97.3%, respectively. In analyzing the area under the curve, sensitivity and specificity for older age and low physical function datasets were significant, but had low values. The diabetes dataset had higher values but did not effectively diagnose sarcopenia at a cutoff value of 4. CONCLUSION: The SARC-F had high specificity for the diagnosis of sarcopenia in community-dwelling older adults with low physical function. However, its sensitivity was low. Despite these limitations, it may be used as a screening tool for sarcopenia in selected populations, such as adults in hospitals or nursing homes.

SARC-F: A validation study with community-dwelling older Japanese adults.

AIM: The SARC-F is a useful clinical index for sarcopenia screening; however, this measure has low sensitivity. Furthermore, this tool has never been validated on community-dwelling older Japanese adults. The goal of the present study was to validate a Japanese version of the SARC-F and confirm its suitability for Japanese samples. METHODS: Participants were 734 community-dwelling older adults in the Itabashi Ward, Japan. Bioimpedance measures, walking speed, grip strength and instrumental activities of daily living (IADL) were measured. Sarcopenia was defined using the European Working Group on Sarcopenia in Older People, the Asian Working Group for Sarcopenia criteria and Japanese-adjusted Asian Working Group for Sarcopenia. SARC-F receiver operating characteristic curves for each sarcopenia measure were used to evaluate diagnostic accuracy. Physical functioning, IADL and sarcopenia screening tools were compared with the SARC-F. RESULTS: A total of nine men (3.1%) and 15 women (3.4%) were classified into a SARC-F sarcopenia group. The sarcopenia group had lower physical functioning and Mini Sarcopenia Risk Assessment scores and higher frailty status than the control group. The Cronbach's alpha for the SARC-F was 0.610, suggesting insufficient internal consistency. SARC-F scores were related to physical functioning, IADL, and Mini Sarcopenia Risk Assessment scores. Receiver operating characteristic analyses of the SARC-F based on each criterion showed low sensitivity, but high specificity. CONCLUSIONS: The Japanese version of the SARC-F appears to be a useful index for reflecting physical functioning and IADL. However, it is necessary to further determine whether this tool is useful for detecting sarcopenia among community-dwelling older adults. Geriatr Gerontol Int 2019; 19: 1172-1178.

Definition of Respiratory Sarcopenia With Peak Expiratory Flow Rate.

OBJECTIVES: Respiratory muscle strength decreases with advancing age, and respiratory muscle dysfunction may indicate respiratory sarcopenia. However, there is no consensus regarding the definition of respiratory sarcopenia. We aimed to create a definition of respiratory sarcopenia based on the peak expiratory flow rate (PEFR). DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: Community-based study including 681 community-dwelling older people. METHODS: Body composition, spirometry, grip strength, and walking speed were measured. Participants reported comorbidities and long-term insurance certification. Conventional sarcopenia was defined using skeletal muscle mass, grip strength, and walking speed adjusted for the Japanese population. Receiver operating characteristic (ROC) curve analysis of the cut-off values of PEFR for conventional sarcopenia and long-term care insurance certification were performed for both sexes without airway obstruction. In the ROC curve analysis, potential cut-off values were lowest quartile, lowest quintiles, and the standard deviation of PEFR. Multiple logistic regression analysis was performed with respiratory sarcopenia as a dependent variable defined by each cut-off value and other variants as independent variables. RESULTS: The ROC curve analysis for conventional sarcopenia and long-term care insurance certification showed significance for both sexes, and we determined cut-off values from those results. The multiple logistic regression model using PEFR values 1 standard deviation below the mean had the highest accuracy; thus, we accepted these cut-off values (4.40 L/s for men, 3.21 L/s for women) for the definition of respiratory sarcopenia. CONCLUSIONS/IMPLICATIONS: The definition of respiratory sarcopenia based on PEFR was useful and correlated with conventional sarcopenia and long-term care insurance certification among community-dwelling older people. In this study, respiratory sarcopenia was determined by PEFR alone. Other parameters may need to be considered.

Relation between knee extension torque and occlusal force in community-dwelling elderly adults.

The relation between occlusal force and general motor ability induced by lower-limb musculature is unclear. To identify indicators of oral and lower-limb muscle weakness, this study examined the relation between masticatory muscle strength and lower limb muscle force in 742 community-dwelling elderly adults (315 men and 427 women, mean age 73.3 ± 5.5 years) living in Itabashi ward, Tokyo. Multiple regression analysis of the relation between occlusal force and knee extension torque, in relation to age and sex, showed a significant correlation between the two variables (r = 0.348, P < 0.001), which indicates that occlusal force is a determinant of knee extension torque. Occlusal force remained significantly correlated with knee extension torque after adjustment for factors known to be related to the latter. In conclusion, chewing function and lower-limb motor function were significantly correlated and thus might be indicators of muscle weakness in elderly adults.

Relationships between serum brain-derived neurotrophic factor concentration and parameters for health scores in community-dwelling older adults.

AIM: Brain-derived neurotrophic factor (BDNF) have been implicated in the progression of neuronal survival, phenotyping differentiation and maintenance of various neurons, as well as neurogenesis. We studied how BDNF affects health parameters of older adults by carrying out a health examination of community-dwelling older adults. METHODS: We measured the serum BDNF concentration of 898 older adults aged 65-84 years who participated in regional health examinations in the Tokyo area and also measured various parameters, such as the thickness of the quadriceps femoris, percentage of body fat, body mass index, grip strength, frequency of walking, and use of sleeping drugs and steroidal anti-inflammatory drugs. RESULTS: We obtained significant relationships between serum BDNF values and thickness of the quadriceps muscle, body mass index or percentage of body fat. Individuals holding onto something when they stood up had lower serum BDNF values than individuals not holding onto something when they stood up. Smokers had higher serum BDNF values than non-smokers. CONCLUSIONS: Older adults who had higher serum BDNF had bigger quadriceps muscles, higher body mass index and higher body fat rate, and were also able to stand up without holding onto something from a sitting position. Geriatr Gerontol Int 2018; 18: 456-461.

Association between statin use and physical function among community-dwelling older Japanese adults.

AIM: Statin-associated muscle symptoms (SAMS) are the muscle-related side-effects of statins, but the association between statin use and physical function among community-dwelling older adults is unclear. The objective of the present study was to examine the association between statin use and physical function among community-dwelling older Japanese adults by considering the risk factors of statin-associated muscle symptoms. METHODS: The participants were 1022 community-dwelling older adults aged 65-88 years, who participated in comprehensive health checkups from 2013 to 2015. Statin use in the participants (381 men and 559 women) was verified by using data from their medicine notebooks. The differences between statin use (users and non-users) and physical functions (grip strength, knee extension torque, normal and maximum gait speed, Timed Up & Go test, one-legged stance, quadriceps muscle thickness and echo intensity) were analyzed using the t-test. Multiple regression analyses were also carried out to examine the association between statin use and physical function. RESULTS: A total of 93 men (24.4%) and 154 women (27.5%) were statin users. Grip strength, normal gait speed and one-legged stance declined significantly in statin users compared with the non-users. In multiple regression analysis while controlling for the risk factors of statin-associated muscle symptoms, including age, sex, body mass index and number of medicines, no independent association, between statin use and the reduction of physical functions, was observed. CONCLUSIONS: Statin use was not associated with the decline of physical function in community-dwelling older Japanese adults. Geriatr Gerontol Int 2018; 18: 623-630.

Comparison of body composition and physical and cognitive function between older Japanese adults with no diabetes, prediabetes and diabetes: A cross-sectional study in community-dwelling Japanese older people.

AIM: Diabetes is associated with not only cardiovascular and cerebrovascular disease, but also reductions in physical and cognitive function. The purpose of the present study was to determine whether muscle strength, walking ability and balance declined in Japanese community-dwelling older adults with diabetes or prediabetes. METHODS: We analyzed data from comprehensive health checkups carried out for 1689 individuals (710 men, 979 women; mean age 71.4 ± 5.6 years) between 2011 and 2016. Participants were divided into three groups: no diabetes (non-history of diabetes and glycated hemoglobin level <5.7%), prediabetes (non-history of diabetes, but glycated hemoglobin level was 5.7-6.4%) and diabetes (history of diabetes or glycated hemoglobin level >6.4%). Physical and cognitive function were compared between groups after adjusting for covariates. RESULTS: Participants with diabetes showed higher levels of obesity, comorbidity, gonarthrosis, and body fat, and lower levels of physical function relative to those observed in participants with prediabetes or no diabetes. After adjusting covariates, participants with diabetes showed significantly lower grip strength (P < 0.010), slower walking speed (P < 0.005), longer Timed Up and Go test time (P < 0.007) and less time spent standing on one foot (P < 0.001) relative to those with no diabetes, but not those with prediabetes. CONCLUSIONS: Significant functional decline was observed in community-dwelling older adults with diabetes, but not in those with prediabetes. Prevention of the progression of prediabetes to diabetes is important in avoiding reductions in physical function. Geriatr Gerontol Int 2018; 18: 1031-1037.

Inverse Association Between Height-Increasing Alleles and Extreme Longevity in Japanese Women.

Growth hormone (GH)/insulin-like growth factor-1 (IGF-1)/insulin signaling is one of the most plausible biological pathways regulating aging and longevity. Previous studies have demonstrated that several single nucleotide polymorphisms (SNPs) in the GH/IGF-1/insulin signaling-associated genes influence both longevity and adult height, suggesting the possibility of a shared genetic architecture between longevity and height. We therefore examined the relationship between 30 height-associated SNPs and extreme longevity in a Japanese population consisting of 428 centenarians and 4,026 younger controls. We confirmed that height-increasing genetic scores (HGSs) constructed based on 30 SNPs were significantly associated with height in the controls (p = 6.95 × 10-23). HGS was significantly and inversely associated with extreme longevity in women (p = .011), but not in men, although no SNPs were significantly associated with extreme longevity after Bonferroni correction. The odds ratio for extreme longevity in the lowest HGS group (≤27) and the second lowest HGS group (28-30) relative to the highest HGS group (≥37) was 1.71 (p = .056) and 1.69 (p = .034), respectively, for women. In conclusion, the present study demonstrated an inverse association between height-increasing alleles with extreme longevity in Japanese women, providing novel insight into the genetic architecture of longevity and aging.

Classification of frailty using the Kihon checklist: A cluster analysis of older adults in urban areas.

AIM: Frailty is an important predictor of the need for long-term care and hospitalization. Our aim was to categorize frailty in community-dwelling older adults. METHODS: The present study was carried out in 2011-2013, and consisted of 1380 individuals over 65 years of age. Participants completed the Kihon checklist, which is widely used to assess frailty in Japan, and their physical, cognitive and social function was evaluated. Non-hierarchical cluster analysis was used to statistically categorize frailty. The optimum number of clusters was determined as the point at which the external reference values (instrumental activity of daily living score, grip power, 10-m walk time, body mass index, portable fall risk index, occlusal force and Mini-Mental State Examination score) differed. RESULTS: According to the Kihon checklist, 369 (26.7%) of the 1380 study participants were considered frail. When the cluster number was increased from two to six, the scores in each subdomain of the Kihon checklist significantly differed. The estimated minimum number of clusters was five, and each of the five cluster groups had distinct characteristics. The numbers of participants in cluster groups 1-5 were 105, 78, 62, 71 and 53, respectively. CONCLUSIONS: We identified five types of frailty in community-dwelling older adults in Japan: "experience of falling," "pre-frailty," "oral frailty," "housebound" and "severe frailty." Geriatr Gerontol Int 2017; 17: 69-77.